The changing model of palliative care

Abstract 

From 19th century roots, palliative care developed in the later part of the 20th century as a social movement and medical specialty. Dr Cicely Saunders was central to its modern development; her vision for improving the care of the dying encompassed the physical, psychological, social and spiritual domains whilst emphasizing the importance of rigorous clinical practice, training and research. St Christopher’s Hospice, which she founded, inspired generations of practitioners and influenced the expansion of hospices nationally and internationally. Terminal care evolved into the discipline of palliative care, which applied holistic principles to the care of those earlier in their disease trajectory and in different settings, such as hospitals and the community. Although established outside the National Health Service in the UK, palliative care became increasingly integrated and recognized as important by the Government, with policy development and funding to support it and the will to extend the scope of palliative care beyond cancer to the care of the dying whatever their diagnosis. Yet, palliative care still reaches only a tiny proportion of those who could benefit from it. The challenge for palliative care in the 21st century is to develop models and coverage appropriate to those in need, whatever their diagnosis, income or setting without losing the original principles of the hospice movement.

Keywords: cancer, end-of-life care, hospice, palliative care, terminal care